Organization
TREE OF LIFE MENTAL HEALTH COUNSELING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTIE IZZO LMHC (OWNER)
(646) 220-4406
Entity
Organization
Contact information
Practice address
2291 VICTORY BLVD, STATEN ISLAND, NY 10314-6625
(646) 220-4406
Mailing address
2291 VICTORY BLVD, STATEN ISLAND, NY 10314-6625
(646) 220-4406
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007045
LICENSE
NY
Enumeration date
04/23/2019
Last updated
06/11/2019
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